Androgenetic alopecia is the medical term for the inherited form of hair loss, and while it affects both men and women, it is men whose anxieties tend to be targeted by the hair loss industry. Estimated to be worth at least £1.5bn a year worldwide, this industry services the needs of millions of men and is becoming increasingly adept at persuading them to part with money.

A casual internet search returns a disorienting array of options that promise to alleviate the misery of the balding man: from herbal remedies to surgical procedures, from magic foams to fancy hairpieces, from restorative shampoos to nanofibre sprays for “colouring in” bald patches. Some of them work, in the sense that the hair loss might be made less apparent, but what succeeds for one person might turn out to be a disaster for another. The resulting arguments play out daily across dozens of websites, helping to generate a smokescreen of confusion behind which snake-oil salesmen can operate freely.

Spencer Stevenson started losing his hair at a young age, and he has spoken widely in the media and online about the trauma it has caused him. His search for a remedy has cost him £40,000 in treatments, including 11 hair transplants, many of which fell way short of his expectations. Since then, he’s become a vocal mentor for those with hair loss, offering advice and detailing his suffering at the hands of what he considers to be a cut-throat industry. “This is the problem,” he says. “It’s governed by money, and there are only a few organisations that have the patient’s best interests at heart. The industry has an ugly reputation for preying on the vulnerable.”

History tells us of men willing to try all manner of bizarre remedies to thwart hair loss. In the Old Testament, the prophet Elisha is taunted for his baldness by a group of boys. He’s sufficiently touchy about this to call for the assistance of God, who promptly summons two bears to maul the boys to death. Harsh, certainly, but it’s worth noting that God chose to exterminate the taunters rather than tackle the hair loss. You can’t really blame him, though. Male pattern hair loss is a very tricky problem indeed.

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According to the UK’s National Institute for Health and Care Excellence (Nice), the condition affects 30% of white men under 30, increasing to around 80% of men over 70 (it occurs less in black men, and later and more slowly in Asian men). Its causes are well established but poorly understood by those of us who have it. We might blame blocked pores, over-shampooing, over-brushing, the water supply or even the remedies we’ve bought, but the truth is that it’s a cruel trick played by nature on the genetically susceptible. Dihydrotestosterone (DHT) is thought to be the hormone responsible. It’s synthesised from testosterone by an enzyme, 5-alpha-reductase, that’s found in the dermal papilla, a small compartment at the base of the hair follicle. This kicks off a process of miniaturisation in hormonally sensitive areas such as the forehead and crown. The dermal papilla cells fall in number, the follicles shrink and, as the American Hair Loss Association puts it, they stop producing “cosmetically acceptable hair”.

With Rooney, you’re not seeing photographs taken from special angles. You’re seeing him running around a football field

Nadeem Uddin Khan

Nadeem Uddin Khan, director of the Harley Street Hair Clinic, was one of the first people in the UK to undergo the FUE (follicular unit extraction) method of hair transplantation, which his clinic now specialises in. FUE is regarded, particularly by younger men, as a successful, modern surgical procedure with minimal stigma. This may be largely down to footballer Wayne Rooney’s two hair transplants, both performed at Khan’s clinic. “He’s been a great ambassador for us, and for hair transplantation in general,” Khan tells me. “It’s led to a massive spike of interest from all around the world.”

After donning protective clothing, I’m led into a surgery, where a man is lying on his back as a doctor uses a special tool to make incisions in his forehead. He spent the morning lying on his front as follicles were extracted from the back of his head; later they’ll be popped into their new location. He confesses that he’s a bit bored, but he’s looking forward to the results. It’s his second op; he was so delighted with the results of the first that he’s come back for another. Rooney, again, turns out to have been the catalyst. “The thing is,” he says cheerily, as the surgeon swabs blood from his scalp, “with Rooney you’re not seeing photographs of his head taken from special angles and with special lighting. You’re seeing him running around a football field, sweating, on the telly, every week. The results are there for everyone to see.”

All hair transplants are based on the principle of donor dominance, developed in the 1950s by New York dermatologist Norman Orentreich: a transplanted follicle doesn’t know it’s been moved; it just continues to grow as if it had been left where it was. Follicles taken from the back and the sides of the head – areas that aren’t sensitive to the miniaturisation caused by the hormone DHT – “remember” their lack of sensitivity when transplanted into bald areas. By the 1980s, experiments with grafting had developed into a procedure known as FUT (follicular unit transplantation) or strip surgery. A strip of the scalp is removed and cut into very small segments, which are then inserted into small holes in the affected area. It’s a quicker procedure than FUE, and is considered by some to be the best way of harvesting high-quality hair. However, it leaves a long scar where the strip has been removed. This scarring, along with a number of poor-quality procedures undergone by celebrities, has given FUT a bad reputation that may not be entirely deserved.

FUE also has its drawbacks. It’s a gruelling process that requires great concentration and stamina on the part of the physician, and enormous patience from the patient. Thousands of individual follicles are selected from across the donor area, extracted with a special tool, kept chilled and later transplanted into tiny incisions. “The procedure for me – around 3,000 grafts – was so labour-intensive that it took all day, from 8.30am to 5.30pm,” says one man who recently underwent an FUE transplant in Australia. “The surgeon gave the sense of approaching her work with an artistic feel, in terms of ensuring consistency with the head’s whorl and general density.”

This is the key to a good FUE transplant, according to Khan. “The right follicle has to go in the right place. Mother Nature doesn’t work in straight lines. These little design details are critical.” Khan shows me the first post-op photographs of the man whose procedure I just witnessed. They’re great. If I had a spare £10,000, I might be persuaded to take the plunge.

Why on earth are men prepared to shell out the price of new car for a patch of hair? The sense that a head of hair bestows on us greater masculinity and sexual appeal is deep-seated, and it’s not something the industry has ever rushed to dispel. In June of this year the Farjo Hair Institute, a British FUE transplant clinic that recently developed a pioneering robot (ARTAS) to perform hair extractions, released the results of an experiment it had done with a patient using the dating app Tinder. It showed that the patient’s post-transplant pictures resulted in 75% more matches than pre-transplant. There was little scientific rigour in this, but men only seem to require a small amount of anecdotal evidence to reinforce their belief that male pattern hair loss is inherently unattractive.

A cure is always five years away – in 10 years it will be five years away. It's the holy grail

Spencer Stevenson

Faced with three options that all have disadvantages – the stigma of wig-wearing, invasive surgical procedures, doing nothing – a comparatively easy way of treating male pattern hair loss might seem to be drugs. However, there are just two approved drugs on the market, minoxidil and finasteride, and it’s generally agreed that neither can reverse hair loss.

The link between minoxidil and hair growth was first noticed in the 1960s by men who took it during trials for a treatment for high blood pressure. The link is still not fully understood, but the US Food and Drug Administration (FDA) approved it as a hair loss treatment for men in 1988 with the proviso that it “will not work for everyone”. Trials have shown some form of regrowth in as many as 80% of patients, but a 2015 review of its efficacy stated that “cosmetically acceptable results are present in only a subset of patients”. Minoxidil is available as an over-the-counter topical medication under such names as Hair Grow, Hairgain, Hairway and Splendora; in the UK and US it’s usually known as Rogaine or Regaine. “It’s a bit of a Band-Aid,” says Stevenson. “It’s a good add-on as part of your regime, but on its own it’s not going to get you too far.”

Finasteride, meanwhile, has been available in the US for hair growth under the name Propecia since 1997. Its hair-growing properties were first noticed by users of Proscar, a 5mg dose of finasteride originally manufactured by Merck for treating enlarged prostate glands. After tests, Merck determined that a 1mg dose was sufficient to promote hair growth. Its workings are better understood than minoxidil’s (it’s thought to inhibit the 5-alpha-reductase enzyme in the dermal papilla) but some of the side effects listed by the FDA, including erectile dysfunction, libido disorders and ejaculation disorders, can put men off. “There are millions of people taking finasteride with no side effects,” says a disgruntled Stevenson, “but you don’t hear from them. I feel sorry for the people who are scared.”

No other medications for male pattern hair loss are licensed by the FDA or its European equivalent, the European Medicines Agency, but there are many dietary supplements that claim to promote healthy hair growth. While there may be a link between poor nutrition and some forms of hair loss, there’s no mention of dietary supplements in the Nice guidance on androgenetic alopecia. Nevertheless, the relative merits of supplements such as TRX2 and Viviscal are vigorously debated.

While those arguments continue, the pursuit of a wonder drug continues, with dozens of companies keen to reap the financial rewards. One, Allergan, has two drugs undergoing trials: a topical one, Bimatoprost, which was originally a treatment for glaucoma and was approved by the FDA in 2008 to assist with the growth of eyelashes; and an oral medication, Setipiprant, which inhibits a compound (prostaglandin D2) that’s found to be elevated in balding scalps. Another company, Samumed, has generated press interest for another potential treatment, SM04554, but some experts find their clinical data to be less impressive than their marketing.

A website, baldattraction.com, encourages men to reclaim their baldness and enjoy the look. Photograph: Johner Images/Getty Images

Differentiating between exaggerated claims and promising initiatives can be a full-time job, according to Dr Susan Holmes, a hair loss expert at the British Association of Dermatologists. “There’s a lot of research being done, and a lot of avenues look interesting, but it’s a question of whether they come through all the rigorous tests to become an effective treatment. Hair is just a difficult thing to make grow.”

That should be the disclaimer on every medicine, every “natural” supplement, every website offering treatments. “A cure is always five years away,” says Stevenson, with a laugh. “In five years, it will be five years away – in 10 years it’ll be five years away. It’s the holy grail. But I think cloning will be a massive industry.”

Successful cloning of hair follicles could give patients a more plentiful source of hair; currently that source is restricted to their limited donor area. “Hair cloning, neogenesis, induction – it’s all the same thing,” says Dr Claire Higgins, lecturer in the Department of Bioengineering at Imperial College London, “but it’s really hard to do.” In a 2013 paper, five scientists including Higgins described how they managed to initiate neogenesis in human skin. “We took human skin and stuck it on a mouse,” she says. “It almost acts like an oven, to cook the tissue, but the hairs were tiny. I think it will work long-term, but we’re trying to map out the genetic changes that are occurring before trying induction again.”

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The work done in Higgins’s lab isn’t driven by a search for a cure for hair loss, but hair happens to be a convenient, accessible model for her to work with. “We think that [during the miniaturisation that causes male pattern hair loss] cells are migrating away from the hair into the surrounding skin,” she says. “The reverse process of that occurs during hair development. Cells migrate together, you get a cluster of cells that’s about double the density of the surrounding cells, which goes on to become the dermal papilla. If I can use the hair to understand this process, how the hair can reprogram the epidermis to change its identity, I think these are basic biological questions that can apply to very different systems.”

Hair regrowth may not be her specific focus but Higgins believes that the psychological issues caused by male pattern hair loss make that work more valuable. “People won’t leave the house,” she says. “It’s not life-threatening, but it is life-changing.”

Susan Holmes mourns the lack of psychological support available on the NHS. “What little there is is hugely oversubscribed,” she says. “There are many people with many different disorders who require the input of a clinical psychologist. We know we can’t cure hair loss, we know that what men need is help to come to terms with it.” But is there any likelihood that balding men like me will ever relish our slow shedding of hair?

Milan Stolicny hopes so. His website, baldattraction.com, offers a joyous, upbeat appreciation of balding heads, and beseeches men with receding hairlines to reclaim their baldness and relish the new perspective it gives them. “Bald is very attractive!” he says. “Bald can wildly succeed in this world! It’s time to kick ass and wildly succeed as a bald man!” Stolicny offers no quackery, no remedies, potions or balsams – just enthusiasm. “The true baldness cure,” he says, “is to become attractive bald man!” In other words, believe in yourself. If balding men were able to do such a thing, a huge industry would collapse overnight. But that industry knows only too well that Stolicny’s solution, while simple, is perhaps the hardest of all to achieve.

This is an edited version of an article that first appeared on Mosaic, the Wellcome Trust’s online science journal, and is republished here under a Creative Commons licence